Occupational Health Disparities

Safety & Health Assessment & Research for Prevention (SHARP)  Research for Safe Work

SHARP Focus on Occupational Health Disparities

The workforce in Washington State is becoming increasingly diverse, reflecting the changing social and demographic characteristics of the country. Major changes are also occurring in the types of employment with increasing numbers working in temporary, contract, or day labor arrangements.

It is likely that some populations within the workforce have greater exposures to physical, chemical, and biological hazards in the workplace. These populations are likely to experience an elevated rate of occupational injuries and illness, or have worse occupational health and employment outcomes. Identifying working populations that experience these inequalities is an area of interest for SHARP's occupational safety and health researchers.

In this issue of SHARP focus, we provide the rationale for 2 SHARP studies. Both studies review data from the Washington State Fund workers' compensation system. The intent of the first study is to evaluate injury rate differences between workers employed by temporary help agencies and those in standard work arrangements. The second study reports on the characteristics of employment, claims administrative, and health outcomes for non-traumatic low back pain claimants based on English or Spanish language preference.

Temporary Workers

Employment trends in the temporary help industry have increased over the past few decades. Data from the 2005 Current Population Survey (CPS) Contingent Workforce Supplement estimate that contingent workers account for 1.8 to 4.1 percent of the United States workforce. It is likely that workers employed by temporary help agencies experience higher physical, biological, and chemical exposures during their periods of employment than workers with standard work arrangements. These potential increased workplace exposures likely translate into comparatively higher work-related injury rates for temporary agency workers to those permanently employed within an industry.

While most of the research conducted on temporary workers and occupational injuries has been done in Europe and Australia, a few focused studies have been conducted in the United States. Foley, in 1998, using a large cohort of Washington State workers' compensation claimants found that temporary workers had higher rates, frequencies and costs of workers' compensation claims than their permanent counterparts, but didn't break down injuries by type. In addition, since the late 1990s temporary help service sectors in Washington State have been a known high-risk industry for upper-extremity musculoskeletal disorders, but to our knowledge, there haven't been any large cohort studies conducted that identify injury rates for other types of injuries in the United States.

The primary aims of this study are to further characterize the demographic, employment and injury experiences of temporary agency workers, and to compare these with their standard employment counterparts by industry and injury type. The identification of types of injury by industry sector can target resources for preventing injuries among temporary agency workers and reduce the occupational health outcome disparities they may face.

Spanish language preference claimants

USA employment trends suggest that the workforce is becoming more racially and ethnically diverse. Workers with limited English proficiency likely experience occupational health disparities. Employment distributions by industry and occupation may predispose racial or ethnic minority workers to more hazardous physical, chemical, and biologic workplace exposures. Workers who are members of racial or ethnic minorities may have less occupational safety and health training, experience greater real or perceived barriers to occupational health services, have less awareness and utilization of workers' compensation (WC) insurance programs, access and use occupational health services differently, and experience worse occupational health outcomes related to longer duration of disability, less disability award amounts, and more adverse social and economic consequences of occupational injury.

Workers' compensation insurance entitles workers to comprehensive medical insurance and indemnity benefits for work-related injuries and illnesses. Each USA state enacts laws and regulations which guide WC insurance administrative practices, benefits and benefit eligibility, and protections intended to safeguard workers against discrimination. This regulatory and statutory oversight should protect against disparities in the administration of WC insurance program entitlements across populations. The absence of race and ethnicity data in WC data complicates assessment for disparities in WC claims administration practices, occupational health outcomes, and potential variation in exposure to occupational health hazards using WC data.

In December 2002, Washington State began to systematically ask WC claimants for their language preference for WC claim communications. Language proficiency may impact the timeliness of WC claim administration activities including determination of claim acceptance, provision of medical and disability benefits, vocational services, and administrative efforts designed to return workers to employment. We used Washington State WC compensable claims data for non-traumatic low back musculoskeletal disorders to assess for occupational health disparities between workers preferring their claims communications in Spanish to those preferring English.